【作者】 盖娟娟；

【导师】 任东林；

【作者基本信息】 广州中医药大学 ， 中西医结合临床， 2006， 硕士

【摘要】 目的 应用多普勒超声痔动脉检测诊断仪特殊设计的肛门镜,对住院行痔手术(包括混合痔外剥内扎术、混合痔吻合器痔上粘膜环切术、超声多普勒引导下的痔上动脉结扎术)、中医辨证为湿热下注型的患者,进行痔上动脉的探测。研究湿热下注型痔痔上动脉血流的分布规律,以期为痔的成因提供客观理论依据,同时也希望为中医辨证提供方便适用和被认可的客观指标。 方法 对符合纳入标准的60例(男42例,女18例)患者进行研究,腰麻后取俯卧折刀位,严格消毒后适度扩肛,将多普勒肛门镜探头涂以足够的石蜡油,把肛门镜插入肛门内,保持探头距齿线2～3cm,以12点位为起始点沿肛管直肠纵轴顺时针旋转肛门镜,在多普勒超声痔上动脉检测诊断仪辅助引导下寻找痔上动脉,在接收到明显的多普勒超声信号且可以听到“噗噗”的动脉血流声为找到痔上动脉,没有信号及动脉血流声为无痔上动脉。通过上述方法,当找到痔上动脉时固定肛门镜,记录此时仪器液晶窗所显示该点位(截石位)的信息,包括距粘膜表面的距离(单位:mm)和血流的振幅(以显示的波峰高低为准,单位:mm)。应用统计软件SPSS13.0建立数据库,将收集的数据准确录入后通过多个独立样本秩和相关性分析得出结果。 结果 对60例患者的研究结果发现:痔上动脉条数最少1条,最多7条,平均4.27±1.148条。以截石位为标准,1～12点位痔上动脉距粘膜表面的距离在3.750±1.282mm～5.526±1.541mm之间,12个点位之间无显著性差异;血流振幅在16.82±0.61mm～17.31±0.88mm之间,12个点位之间也无显著性差异。 痔上动脉出现频率最多的依次是11、7、3点位(分别是81.7%、68.3%、63.3%),其次是9、1、5点位(分别是40.0%、38.3%、35.0%),最少的是6点位(6.7%)。 60例研究对象均为非环状痔患者,痔核共计176个,平均每例2.93个,其中占据1个点位的为32个(18.18%),占据2～3个点位的为102个(57.95%),占据3个点位以上的为42个(23.86%);176个痔核中跨越3、7、11点位的有148个(84.10%)。 共测得痔上动脉279条,无痔上动脉的痔核为31个(17.61%),有痔上动脉的痔核为145个(82.39%),其中有1条痔上动脉的痔核为39个(22.16%),2条痔上动脉的痔核为80个(57.35%),3条及3条以上痔上动脉的痔核为26个(9.32%)。 结论 1.痔上动脉多于3条,因此原来的三分支(3、7、11点位)模式可能存在疑问,尚需进一步探讨。更多还原

【Abstract】 ObjectiveIn using special design anoscope of the Doppler supersonic hemorrhoidial artery examination diagnostic equipment, survey the hemorrhoidial blood stream to the hospitalized patients of hemorrhoidial surgery (including Milligan—Morgan, PPH, DG—HAL), and the Chinese medicine sign of downward flow of damp-heat. The objective of studies is hemorrhoidial the artery blood stream distributed rule, provides the theory basis for the hemorrhoidial origin, at the same time also hoped to provides the convenient, suitable and approvable objective target for the Chinese medicine . MethodsTo tallies brings into line with the standard 60 examples (male 42 examples, female 18 examples) the patient conducts the research, after the waist hemp takes lies face downwards the jackknife position, after the strict disinfection moderately expands the anus, pokes head in the Doppler anoscope to spread by the enough paraffin oil, the anoscope insertion anus in, the maintenance pokes head in to be apart from dentate line 2-3cm, along the anal canal rectum ordinate axis clockwise rotation anoscope, seeks the hemorrhoidial artery under the Doppler supersonic hemorrhoidial artery examination diagnostic equipment assistance guidance, in receives to the Doppler supersonic signal most obvious time fixed anoscope, the recording this time the instrument liquid crystal window demonstrates this position (truncation stone position) the information, Including is apart from the mucous membrane surface the distance (the unit:mm) and the blood stream oscillation amplitude (take the wave ridge height which demonstrated as, unit:mm). Using the statistical software SPSS13. 0 establishment database, after the data accurate input which collects obtains the result through manyindependent samples order and the relevant analysis. ResultsDiscovered to 60 examples patients’ findings that, In hemorrhoids artery strip number least 1, more than 7 strip, average 4.27 + 1. 148 strip. By the standard of lithotomic position, in 1-12 positions hemorrhoids the artery is apart from the mucous membrane surface the distance in 3. 750+ 1. 282mm-5. 526+ 1. 541mm between, between 12 spots positions does not have the significance difference;The blood stream oscillation amplitude in 1. 682 + 0. 061cnrl. 731 +0. 088cm between, between 12 spots positions also does not have the significance difference. In the hemorrhoids the artery appears the frequency most to be many in turn are the 11, 7, 3 positions (respectively is 81. 7%), Next is 9, 1, 5 positions (respectively is 40.0%. Least is 6 positions (6.77%, 11 positions) is the center surmounts 2-3 spots positions primarily. In the hemorrhoids the artery distribution and the blind pile good send the spot to have the close relation but is not 11 corresponding relations, often has 2-3 arteries supplies in blind pile obvious position its hemorrhoids. Conclusions1. There are more than 3 arteries in the hemorrhoids, therefore the original three branches (3,7, 11 positions) the pattern possibly has the question, still had further to discuss.2. In the hemorrhoids the artery distributed and the female hemorrhoids zone (3, 7, 11 positions) have the close relation, also in the odd number position hemorrhoids the artery distribution compares an even number position crowdedness.3. 6 positions blood streams distribution least, after possibly is 6 positionsis easy to have anal fissure as well as the hemorrhoids excision restores one of slow reasons.4. The rectum lower segment and the anal tube blood supplies, in is apart from dentate line 2-3cm place depth basic to be consistent, also the artery capacity does not have the obvious difference.5. Hemorrhoids good sent the spot still was taken the female hemorrhoids area(3,7,11 positions) as the core surmounts 2-3 spots positions primarily.6. In hemorrhoids the artery distribution with hemorrhoids good sends the spot to have the close relation but is not corresponding relations, in the hemorrhoids may have 2 even 3 arteries supplies.7. Carries on for the first time in the living specimen to the human rectum lower segment blood stream does not have the creating determination accurately, the method simple is feasible.8. As one new methodology, may use in through the blood stream determination carrying on the curative effect appraisal to the hemorrhoids in.更多还原